OPM Launches Health Insurance Review to Remove Ineligible Family Members

The Office of Personnel Management (OPM) is launching a new verification process requiring federal employees to prove family members added to their health plans are eligible for coverage. This as OPM estimates that ineligible enrollees may be costing the federal government up to $1 billion a year. 

According to a final rule published in the Federal Register that takes effect July 1, agencies must verify the eligibility of all family members enrolled in the Federal Employees Health Benefits (FEHB) Program and the Postal Service Health Benefits (PSHB) Program.

Employees will have to show documents proving their covered family members are eligible– including marriage certificates, birth certificates, foster or adoption paperwork, and tax returns. It applies to both regular Open Season as well as qualifying event enrollments, such as birth, adoption, or marriage. 

Covered family members include a spouse, children under the age of 26, and in certain cases an adult dependent over the age of 26 who is disabled.

OPM notes that uncovered family members include a grandchild (unless they qualify as a foster child), a former spouse, and a domestic partner. The agency estimated four million family members enrolled in FEHB and PSHB in 2025– and that about three percent of those enrollees are ineligible.

If documents are not provided, either OPM or the employing agency can remove the dependent.

Verification and Upcoming Audit

The rule change stems from the FEHB Protection Act which was part of the One Big Beautiful Bill Act passed last summer. The FEHB Protection Act requires OPM to create an eligibility verification process and a method for removing currently enrolled ineligible members.

The crackdown comes after the Government Accountability Office (GAO) reported in 2022 that the federal government may be spending up to $1 billion a year to cover people who don’t qualify for FEHB. 

In addition to expanding the eligibility verification process, OPM said it is preparing an audit of currently enrolled family members.

Family members found ineligible could be removed from coverage, and employees could see higher costs if their enrollment category changes as a result.